Dilated cardiomyopathy (DCM) is one of the most common forms of non-ischemic cardiomyopathy, characterized by dilation and systolic dysfunction of the left ventricle. The disease is associated with a high risk of adverse outcomes, including decompensation of chronic heart failure (CHF) and sudden cardiac death (SCD). Traditionally, the identification of candidates for implantable cardioverter-defibrillators (ICDs) for primary prevention of SCD has relied on the left ventricular ejection fraction (LVEF ≤ 35

To assess the accuracy of virtual stenting based on angiography–physiology coregistration of instantaneous wave-free ratio (iFR) pullback for predicting the immediate physiological result of percutaneous coronary intervention (PCI) in patients with multilevel coronary artery disease. Physiological assessment of serial or diffuse coronary disease remains challenging because angiography frequently overestimates lesion extent and cannot reliably identify the arterial segments responsible for the dominant pressure loss. iFR pullback with angiographic coregistration enables functional lesion mapping and simulation of the expected post-PCI physiological result. This prospective single-center observational study included 50 patients with chronic coronary syndrome and multilevel coronary stenoses. One target vessel per patient was included in the final analysis to avoid within-patient clustering of multiple vessels. All interrogated vessels had a baseline iFR value of 0.89 or lower. PCI planning was initially performed on the basis of coronary angiography and was then reassessed using iFR pullback with SyncVision angiography-physiology coregistration. Virtual stenting was used to estimate the predicted post-PCI iFR value (iFRpred). After PCI and procedural optimization, the final observed post-PCI iFR value (post-iFR) was measured. The primary end point was agreement between iFRpred and post-iFR, assessed as both a continuous difference and a prespecified binary threshold of poor agreement defined as an absolute difference of 0.03 or greater. iFR increased significantly from 0.78 ± 0.11 at baseline to 0.93 ± 0.04 after PCI (p < 0.001). The predicted post-PCI iFR was significantly higher than the observed post-PCI iFR (0.95 ± 0.03 vs. 0.93 ± 0.04; p < 0.001). iFR pullback changed lesion classification and PCI planning, with disagreement between angiography-based and physiology-based identification of target lesions in 30 patients (60.0

To obtain reference ranges for heart rate variability (HRV) parameters in healthy children, taking into account their gender and age. The study included the results of testing 22,468 children ranging 5.5-12.5 years of age. The data were grouped by age and gender. The analysis of HRV parameters was carried out according to the standards described in existing guidelines. It was based on a 5-min rhythmogram obtained from a standard 12-lead electrocardiogram (ECG). The following characteristics of the temporal and spectral analyses of HRV were studied: standard deviation of NN intervals (SDNN), power in the low-frequency band of the HRV spectrum (LF), low-frequency power as mean percentage of total power (TP) of HRV spectrum (LF%), power in the high-frequency band of the HRV spectrum (HF), high-frequency power as mean percentage of TP of HRV spectrum (HF%), power in the very-low-frequency band of HRV (VLF), and LF/HF ratio. The values of SDNN, LF, HF, HF% and TP increased with age, reaching a peak at 8 and 9 years of age. It is notable that the values of SDNN, LF and TP were significantly lower in girls in each age group. The values of LF% and LF/HF decreased with age, with a peak decrease at 8 and 9 years of age, followed by a moderate increase or stabilization. The values of LF% and LF/HF did not differ statistically significantly between boys and girls. The VLF parameter exhibited a clear trend of growth with age and had higher values in boys of each age group. The correlation between HRV and heart rate (HR) was statistically significant. The correlation graphs had similar curves in both gender groups and both age groups. The parameters of the total HRV, as well as the activity of the parasympathetic nervous system (PNS), exhibited similar growth trends with age, with a peak increase in their values at 8 and 9 years of age. HR, as well as the activity of the sympathetic nervous system (SNS), decreased with age. Gender differences also followed a consistent pattern: parameters characterizing the activity of the peripheral nervous system were significantly higher in boys than in girls across all age groups.

Цель. Оценка влияния ожирения, рассчитанного по индексу массы тела (ИМТ), на госпитальные результаты и трехлетнюю выживаемость после операции коронарного шунтирования (КШ) у больных ишемической болезнью сердца (ИБС).

We suggest a new method for the detection of paroxysmal atrial fibrillation by analyzing surface-enhanced Raman scattering (SERS) spectra of blood serum of patients in question in comparison with SERS spectra of the serum of healthy donors. Spectral measurements were carried out on compact SERS substrates in dried blood serum droplets with immediate subsequent processing. To process the spectra, machine learning methods were used, in particular, the logistic regression method and the principal component method. Furthermore, thanks to the possibility of the physical-chemical interpretation of the coefficients of the method, the vibrational bands responsible for the signs of atrial fibrillation were identified and their correlation was carried out. Evaluation metrics were presented for the classification, among which the accuracy value was 0.82, that is a high indicator when analyzing samples directly from the blood serum of patients with the disease under study. It was shown that a small number of measured spectra for each sample (near 35 measurements) was sufficient to carry out the study. A comparative analysis of the logistic regression method and other commonly used machine learning methods was also carried out: support vector machines and random forest. Each method was evaluated and the advantages of logistic regression in solving the problem presented in this study were shown. The receiver operating characteristic curve (ROC) analysis was also used for graphical representation and comparison of methods. The presented study shows the prospects for using the described method for the analysis of diseases associated with cardiac risks.

Coronary heart disease (CHD) remains a leading cause of mortality among cancer patients, primarily due to shared risk factors and the impacts of chemotherapeutic drugs, immune checkpoint inhibitors, and radiotherapy. Determining the optimal treatment strategy remains a challenging issue for patients with concurrent CHD and malignant neoplasms. In high-risk patients, managing CHD frequently takes precedence over addressing the oncologic disease. Myocardial revascularization, coupled with optimal medical therapy for CHD, can significantly enhance patient survival by reducing the risks of myocardial infarction and sudden cardiac death. However, selecting a surgical treatment strategy requires careful consideration of the indications, the complexity of coronary lesions, the risk of bleeding and thrombosis, and the overall prognosis of the malignancy. This clinical case demonstrates the importance of risk-benefit assessment, multidisciplinary discussion of cure strategy, and application of novel technologies to provide the most personalized and effective treatment.

Background: Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. Material and Methods: This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up—6 years). Results: The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048–4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. Conclusions: This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment.

Introduction: Hypoplastic left heart syndrome is a critical congenital heart disease that takes a leading place in the structure of mortality index, caused by congenital heart disorder, despite its low degree of incidence (up to 0.2 per 1,000 births). Objective: The study aimed to present a new approach to the arranging of highly specialized medical care for newborns and infants with hypoplastic left heart syndrome, which includes a complex of surgical, medicamentous and outpatient preventive care for children of the first year of life, both at inpatient and interstage treatment periods.Methods: The methodology consists of 5 stages. Stage 1 is aimed at bilateral pulmonary artery banding; Stage 2 is associated with prolonged infusion of prostaglandin E1, and symptomatic therapy including, if necessary, the Rashkind procedure, for at least 18 days; Stage 3 is Norwood operation; Stage 4 is dynamic inpatient and outpatient observation and treatment; Stage 5 is operation of bidirectional cavopulmonary anastomosis. Results: 8 patients were treated using the proposed methodology. All of them underwent bilateral pulmonary artery banding followed by Norwood’s operation, with no deaths. During dynamic observation, three patients required stenting of the aorta’s isthmus after the Norwood operation. One patient died later at his place of residence. Six patients underwent bidirectional cavopulmonary anastomosis, with no deaths. Conclusion: The proposed approach of multi-stage treatment of patients with hypoplastic left heart syndrome allows improving immediate results after the Norwood operation and reducing inter-stage mortality through early detecting and eliminating of possible complications. Received 19 January 2024. Revised 19 May 2024. Accepted 22 May 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Svobodov, E.G. Levchenko, D.A. GorbanData collection and analysis: A.A. Svobodov, E.G. Levchenko, D.A. GorbanStatistical analysis: A.A. Svobodov, M.V. MakarenkoDrafting the article: A.A. Svobodov, M.R. Tumanyan, A.I. Kim, E.G. Levchenko, A.Yu. Ergashov, D.A. GorbanCritical revision of the article: A.A. Svobodov, M.R. Tumanyan, A.I. Kim, E.G. Levchenko, R.S. Gulasaryan, E.Z. GolukhovaFinal approval of the version to be published: A.A. Svobodov, M.R. Tumanyan, A.I. Kim, E.G. Levchenko, A.Yu. Ergashov, R.S. Gulasaryan, D.A. Gorban, M.V. Makarenko, E.Z. Golukhova

In the updated diagnostic criteria for arrhythmogenic cardiomyopathy (ACM) (2020 and 2022), magnetic resonance imaging (MRI) has become the preferred method for cardiac imaging. This is due to advances in MRI and the accumulation of evidence on its reliability. Non-invasive assessment of myocardial fibrotic replacement using late gadolinium enhancement techniques is a key innovation, which, along with histology data, was included in the category of "structural changes". The technique has demonstrated significance in identifying various ACM phenotypes (primarily the left ventricular one), in differential diagnostics and family screening of the disease. The relevance of MRI data has been proven in predicting the risks of adverse cardiovascular events, including sudden cardiac death. Some MRI techniques, such as T1 mapping and myocardial strain assessment, are under study, but they have already shown promise in studies on small groups. Obtaining and interpreting cardiac MRI data in patients with ACM requires not only standardized protocols and high experience of a radiologist, but also teamwork with cardiologists. The article summarizes the current capabilities of MRI in ACM and provides a practical approach to diagnosis and risk stratification.

BACKGROUND: A comprehensive approach to studying hypertrophic cardiomyopathy with diagnostic equipment and the latest scanning methods will ensure quality control and effective treatment of patients with this condition. The implementation of innovative technologies and computer calculation using next-generation scanners may become relevant and promising in studying various phenotypes of left ventricular remodeling in combination with abnormalities of the chordopapillary apparatus of the mitral valve and myocardial structure. AIM: To examine the diagnostic capabilities of computed tomography in the preoperative examination of various hypertrophic cardiomyopathy phenotypes. MATERIALS AND METHODS: The retrospective data analysis included 47 patients with hypertrophic cardiomyopathy (mean age, 52±7 full years) before surgical correction. computed tomography was performed using our protocol with automatic bolus tracking in the left atrium with a 90 HU threshold and biphasic contrast injection to assess the heart chambers and coronary arteries anatomy and mitral valve morphology. Moreover, to assess myocardial structure remodeling, iodine dual-energy computed tomography maps obtained with delayed contrast enhancement were analyzed. All patients with hypertrophic cardiomyopathy were classified by morphological types. The anatomy of chordopapillary apparatus was evaluated in each case. RESULTS: This study demonstrated variability in hypertrophic cardiomyopathy phenotypes, which were conventionally divided into five morphological categories, but not restricted by them. Among the patients, 26 (55%) had diffuse septum hypertrophic cardiomyopathy, 5 (11%) had midventricular hypertrophic cardiomyopathy, 2 (4%) had midventricular obstruction and apical aneurysm, 8 (18%) had focal basal septum hypertrophic cardiomyopathy, 4 (8%) had concentric hypertrophic cardiomyopathy, and the remaining 4 (8%) had apical hypertrophic cardiomyopathy. Most patients were diagnosed with chordopapillary abnormalities of the mitral valve, categorized by papillary muscle number and position, and the ratio of chords to muscles. In 10 (21%) patients, data on the myocardial bridge of a coronary artery were obtained, whereas 3 (14%) of them had dynamic stenosis. All patients had focal iodine uptake on dual-energy computed tomography maps. An extracellular volume increase was observed in 10 out of 13 (76%) patients. As shown by dual-energy computed tomography, the mean extracellular volume of the left ventricular myocardium was 30.58% (95% confidence interval, 27–34%). CONCLUSION: Our scanning protocols developed with computed tomography scanners of various generations enable to evaluate the specific morphological patterns of hypertrophic cardiomyopathy in a single study and provide a detailed interpretation of the geometry of cardiac valves and chambers, left ventricular function, state of the coronary bed, and structural changes of the left ventricular myocardium.

AIM:This study aimed to evaluate the prognostic value of T1 mapping techniques via cardiac magnetic resonance (CMR) in nonischemic dilated cardiomyopathy (NICM) patients. MATERIALS AND METHODS:PubMed and Google Scholar were searched for studies examining the prognostic value of myocardial tissue characterization via CMR imaging with T1 mapping in NICM. Major adverse cardiac events (MACE) included cardiac death, ventricular arrhythmia/sudden cardiac death (SCD) events, and heart failure events. RESULTS:Ten studies with a total of 3,384 patients (mean age 50.4 years; mean follow-up 28.0 months) were analyzed. The meta-analysis demonstrated that in patients with MACE, the mean extracellular volume (ECV) was greater than in those without MACE (MD: -5.40%; 95% CI: -7.91 to -2.90%; p < 0.0001). Furthermore, in patients with MACE, the native T1 value was also greater than in those without MACE (MD: - 38.87 ms; 95% CI: -59.01 to -18.74 ms; p = 0.0002). A meta-analysis showed a significant relationship between ECV and the risk of MACE (HRunadjusted: 1.19 per 1% ECV; 95% CI: 1.10-1.28; p < 0.001). After adjusting for baseline characteristics, higher ECV remained strongly associated with MACE risk (HRadjusted: 1.21 per 1% ECV; 95% CI: 1.11-1.31; p < 0.001). Higher native T1 time was also significantly associated with MACE development (HRunadjusted: 1.09 per 10 ms T1 time; 95% CI:1.02-1.15; p = 0.007). After adjustments, the association remained significant (HR adjusted: 1.01 per 10 ms T1 time; 95% CI: 1.00-1.03; p = 0.02). CONCLUSIONS:Meta-analysis demonstrates the risk of MACE being significantly associated with a higher mean ECV fraction and native T1 time, suggesting these indices as novel risk markers to identify high-risk NICM patients.

Primary radical correction of tetralogy of Fallot (ToF) is an optimal surgical option; however, in some conditions, in particular with concomitant extracardiac pathology and hypoplasia of the pulmonary artery (PA) branches, this intervention is not possible. Obstruction and/or hypoplasia of the PA is one of the risk factors for primary radical correction of this congenital heart defect (CHD). In world practice, there are several methods of palliative approach for PA growth with the possibility of further radical correction. However, in some cases, palliative approaches do not give the desired result. In this regard, we present a clinical case of a successful hybrid bifurcation Y-stenting of the PA and radical correction of ToF. Keywords: Tetralogy of Fallot, radical correction, branches of the pulmonary artery, hypoplasia, stenting of the branches of the pulmonary artery, bifurcation Y-stenting, clinical case.

Актуальность. Синдром гипоплазии левых отделов сердца — критический врожденный порок сердца, занимающий ведущее место в структуре смертности от врожденных пороков, несмотря на низкую распространенность (до 0,2 на 1 000 новорожденных). Цель. Представить комплекс хирургической, медикаментозной и амбулаторно-профилактической помощи новорожденным и детям первого года жизни с синдромом гипоплазии левых отделов сердца в стационарном и межстадийном периодах лечения. Методы. Методика состоит из 5 этапов: 1-й этап — раздельное суживание легочных артерий; 2-й этап — продленная инфузия простагландина Е1 и симптоматическая терапия (в том числе процедура Рашкинда по показаниям). Рекомендованная длительность этапа — не менее 18 дней — при необходимости увеличивается или уменьшается в зависимости от вида осложнений. В настоящем исследовании рекомендованную продолжительность соблюли 3 из 8 пациентов, в остальных случаях этап длился 9–15 дней; 3-й этап — операция Норвуда; 4-й этап — динамическое стационарно-амбулаторное наблюдение и лечение; 5-й этап — двунаправленный кавопульмональный анастомоз. Результаты. По предлагаемой методике пролечено 8 пациентов. Всем выполнили раздельное суживание с последующей операцией Норвуда без летальных исходов. В процессе динамического наблюдения 3 больным провели стентирование перешейка аорты после операции Норвуда. Один пациент умер по месту жительства. Шести больным выполнили двунаправленный кавопульмональный анастомоз без летальных исходов. Заключение. Предлагаемый подход многоэтапного лечения пациентов с синдромом гипоплазии левых отделов сердца позволяет улучшить непосредственные результаты операции Норвуда и снизить межстадийную летальность вследствие раннего выявления и устранения осложнений. Поступила в редакцию 19 января 2024 г. Исправлена 19 мая 2024 г. Принята к печати 22 мая 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.А. Свободов, Е.Г. Левченко, Д.А. Горбань Сбор и анализ данных: А.А. Свободов, Е.Г. Левченко, Д.А. Горбань Статистическая обработка данных: А.А. Свободов, М.В. Макаренко Написание статьи: А.А. Свободов, М.Р. Туманян, А.И. Ким, Е.Г. Левченко, А.Ю. Эргашов, Д.А. Горбань Исправление статьи: А.А. Свободов, М.Р. Туманян, А.И. Ким, Е.Г. Левченко, Р.С. Гуласарян, Е.З. Голухова Утверждение окончательного варианта статьи: все авторы

Цель. Изучить взаимосвязь степени фиброза миокарда левого предсердия (ЛП) с риском рецидива фибрилляции предсердий (ФП) после катетерной изоляции легочных вен (КИЛВ).

The guidelines contain a description of providing outpatient follow-up of patients with atrial fibrillation and flutter by a general practitioner, the approximate volume and frequency of paraclinical studies, information on the diagnosis and treatment of the disease, and the prevention of complications.The guidelines are intended for district primary care physicians, general practitioners (family doctors), as well as for the nursing staff, for paramedics of the rural health posts if they are assigned the attending physician functions. The guidelines can be used by health professionals, heads of primary healthcare facilities and their divisions.